Transcranial Magnetic Stimulation (TMS)

What is TMS?

Butler Hospital-What is TMSTranscranial Magnetic Stimulation (TMS) is a revolutionary treatment, approved by the FDA, for patients suffering from depression that did not respond to standard medications and therapy. A device placed on the patient’s head delivers targeted magnetic pulses that penetrate the scalp and skull to induce activity in brain cells (called neurons) underneath the scalp in an area called the prefrontal cortex. TMS therapy is a non-invasive treatment and it does not require anesthesia or sedation. Patients remain fully awake and alert during their TMS treatment sessions and they can travel independently to the clinic and continue with their day to day activities without limitation.

TMS therapy can be given alone, or as an add-on to ongoing psychiatric medications. Published reports from TMS treatment studies show more than half of patients treated with TMS therapy experienced significant improvements in depression symptoms and about one-third of patients experience remission of the depressive episode. TMS treated patients have experienced significant improvements in their anxiety, functioning, pleasure, appetite changes, aches and pains, and lack of energy, and other debilitating symptoms associated with their depression.

Contact Information:

TMS Clinic
Butler Hospital
345 Blackstone Boulevard
Delmonico 1A
Providence, RI 02906
P: (401) 455-6632
F: (401) 455-6686
Email: TMS@CareNE.org

Click here to begin the screening process with our TMS team.

Clinic Hours: Monday-Friday 8:00 am-5:30 pm

For Physicians
For clinicians, if you would like to refer your patient for consideration of TMS Therapy, please download and complete this form and fax to (401) 455-6686.

An Honest Conversation About TMS

 

Linda Carpenter, MD

TMS Therapy at Butler Hospital

In October of 2008, the FDA approved the first TMS device to treat depression, and Butler Hospital’s TMS Clinic team includes researchers who have continued to study TMS since that point in time. The Butler TMS Clinic was opened to the public for non-research standard care in January 2009 and has remained one of the busiest TMS programs in the Northeast since then. Our state-of-the-art treatment facility houses multiple FDA-cleared devices for standard TMS clinical care, as well as investigational devices for research clinical trials. TMS researchers at Butler continue to conduct investigations aimed to make the TMS therapy outcomes even better and more personalized for each patient.

A typical course of TMS therapy includes:

  • Thirty daily treatment sessions, five per week; Monday through Friday (followed by six "taper phase" treatments given over a span of three weeks).
  • Serial assessments of symptoms/response with standardized rating scales.
  • Collaboration between the TMS team and a patient's regular outpatient care team during the course of TMS therapy. Butler TMS patients will continue to meet with their outpatient clinicians and prescribers for medication management and psychotherapy.
  • An end-of-treatment summary of their TMS course is sent to the patient's treating clinicians to document outcomes, plans, and recommendations.
  • A repeat course of TMS therapy is covered by most insurance policies for patients who showed a positive response to a past course of TMS and experienced subsequent depression relapse.

We strive to make the process of referring patients with treatment-resistant depression to the Butler TMS Clinic as easy and effective as possible. Most of our patients receive TMS therapy as a covered service through their health insurance policy. As such, we go the extra mile to obtain source documentation of past treatment history. Typical eligibility requirements for insurance coverage of TMS include a patient:

  • Current primary diagnosis of unipolar major depressive disorder (MDD), single episode, or recurrent episode without psychotic features.
  • Current episodes characterized by a moderate to severe level of current depressive symptoms (standardized rating scales are used to access severity).
  • The patient has the ability to remain safe and is sufficiently stable for treatment on an outpatient basis.
  • History of adequate trials of several antidepressant medications in the current episode, or documented intolerance to several attempted medication trials.
  • Exposure to several different pharmacological classes of medications during current and past treatment for depression (SSRI, SNRI, atypical antipsychotics, augmentation agents).
  • A patient may or may not have had a past trial of electroconvulsive therapy (ECT). To date, the history of past ECT is not related to TMS response.

For additional information, please click here  to hear Dr. Linda Carpenter, lead TMS expert and the director of the TMS Clinic at Butler Hospital, speak about TMS Therapy.

Is TMS Therapy covered by Insurance?

TMS treatment for depression is covered by nearly all insurance carriers including Medicare and Medicaid. A screening process is used to determine whether each patient meets their insurance policy’s coverage criteria. An outpatient appointment, called a TMS Consultation visit, takes place with a TMS physician prior to starting the course of TMS therapy. When a patient is determined to be eligible, our TMS Clinic staff will submit the required pre-authorization information and work with insurance companies to obtain coverage.

A typical course of TMS therapy includes:
  • Thirty daily treatment sessions, five per week; Monday through Friday (followed by six "taper phase" treatments given over three weeks)
  • Serial assessments of symptoms/response with standardized rating scales
  • Collaboration between the TMS team and a patient's regular outpatient care team during the course of TMS therapy: Butler TMS patients continue to meet with their outpatient clinicians and prescribers for medication management and psychotherapy
  • An end-of-treatment summary is sent to the patient's treating clinician to document outcome and recommendations
  • A repeat course of TMS therapy is covered by most insurance policies for patients who showed positive response to initial acute course of TMS and experienced subsequent depression relapse

How Does TMS Work?

TMS is non-invasive, does not involve the insertion of intravenous lines or surgery, and does not require any anesthesia or sedation.

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TMS Safety Concerns

Over 10,000 TMS treatments were safely performed during clinical trials with the type of TMS device used at Butler Hospital.

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Frequently Asked Questions

Have questions about what to expect as a patient or who will be involved in the treatment? We've got you covered.

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Are you a candidate for TMS?

To find out if you are candidate for TMS, you can begin the screening process by calling (401) 455-6632 or by filling out the form below and someone on the team will be in contact with you shortly.

Don't take our word for it

TMS is my lifesaver. The treatment I received is beyond compare.  It is a very healing environment with the most amazing staff. When I am here, I know I am in the best, most capable hands. 
January
2020

I want to thank you for changing my life. When I first came in for a consultation I didn’t know what to expect. You were open and honest. This was my last hope to feel better. I can’t thank you enough for changing my life. You have given me hope for the future. I feel like my life has just begun.

January
2020

Thank you for being a part of my journey for better mental health. It has been great working with all of you and I need you to know that. What you do is amazing!

December
2019

You will never know how much I appreciate your guidance through the past few months. You’ve been the best cheerleaders anyone could ask for. Seeing your smiles every morning and hearing your kind words made each treatment comfortable and I admire your professionalism and dedication to the TMS program.

October
2019
I want to thank you for all that you’ve done to help me get to a better place. When I came in for my first treatment I was so nervous. I was so grateful for everyone’s smiles, reassurance, and thoughtfulness through my treatments. You have done do much for me- you allowed me to have hope for a better future.
January
2020

Meet the Team

Butler Hospital TMS Clinic

Linda Carpenter, MD

Director, Butler TMS Clinic and Neuromodulation Research Facility

Linda L. Carpenter, MD is a Professor of Psychiatry in the Alpert Medical School of Brown University and Chief of the Mood Disorders Program at Butler Hospital. She completed her undergraduate degree at the University of Michigan and medical school at the University of Pennsylvania. She did an internship in internal medicine, psychiatry residency, and research fellowship at Yale, and then joined the faculty at Brown in 1997. She has continued her path since then as a physician-researcher investigating the neurobiology of, and new treatments for, major depression and other mood and anxiety disorders. Dr. Carpenter has also conducted a number of randomized clinical trials sponsored by industry and NIH, investigating investigational drugs and devices for treating depression, including esketamine, Vagus Nerve Stimulation (VNS), Deep Brain Stimulation (DBS), Transcranial Magnetic Stimulation (TMS) and transcranial Direct Current Stimulation (tDCS). She is the founding Director of the Butler Hospital TMS Clinic and Neuromodulation Research Facility and co-author of several published TMS Clinical practice guidelines. Dr. Carpenter was engaged in TMS research prior to the first FDA clearance in 2008, and has remained active as a TMS clinician and researcher since then. She is a faculty member of several national TMS training courses and serves on the Board of Directors of the Clinical TMS Society. She is a member of the American Psychiatric Association (APA) Council on Research and has published extensively on TMS and other treatments for depression. 

Joshua Brown, MD, PhD

TMS Associate Director

Dr. Joshua Brown is an Assistant Professor of Psychiatry and Neurology in the Research Scholar Track at the Warren Alpert Medical School of Brown University. He is the Associate Director of the TMS clinic at Butler Hospital. He has a B.S. in Psychology from the University of Utah, an M.D. and Ph.D. in neurobiology, studying mechanisms of synaptic plasticity, from the Medical Scientist Training Program at the Medical College of Wisconsin. He completed an internship in Internal Medicine, a residency in “Brain Medicine” (combined Psychiatry and Neurology), an Interventional Psychiatry Track, and a concurrent research fellowship in brain stimulation at the Medical University of South Carolina in 2020.At Butler, his clinical work is primarily focused on providing Transcranial Magnetic Stimulation (TMS) for patients with treatment-resistant depression. He also studies how TMS causes lasting therapeutic changes to the brain.

Eric Tirrell

TMS Clinical Supervisor/Neuromodulation Research Facility Coordinator

Mr. Eric Tirrell completed his undergraduate degree in psychology at the University of Rhode Island.  He is the TMS clinical supervisor of Butler Hospital’s TMS Clinic and has been providing TMS treatment for major depressive disorder for over 5 years. He has extensive experience with all aspects of TMS clinical care and he is well versed in operating Neurostar, Magstim, Nexstim, and other investigational TMS device systems using a variety of TMS protocols. In addition to his role on the TMS clinical service, Eric also serves as the Research Coordinator for Butler’s Neuromodulation Research Facility. He works with a number of Brown University-based faculty and with project leaders and research staff in Butler’s COBRE Center for Neuromodulation to incorporate noninvasive brain stimulation techniques into their clinical research. He has had extensive training in the collection of physiological data and brain imaging for biomarker development and investigating brain network function and connectivity. His goals are to help develop optimized individual neuromodulation approaches for depression and to ultimately use TMS as a treatment modality for a wide range of conditions and neuropsychiatric disorders.

Ashley Logan

Lead TMS Technician

Ms. Ashley Logan completed her undergraduate degree in Sociology at Rhode Island College in Providence, RI. She is the Lead TMS Clinical Technician and has been providing TMS Treatment for Major depressive disorder for 3 years. She is well versed in operating the different TMS devices, while using various protocols. She spent time throughout college involved in different groups focusing on LGBTQ+ inclusion and advocacy on campus, as well as educational event planning dedicated to raising awareness on a plethora of topics including: partner violence, addiction, and community resources. Her main focus in the clinic is to help provide the best care for each individual person through a welcoming space, built trust and a well versed team that all work cohesively with the single goal of getting people better.

Katelyn Audette

TMS Technician

Ms. Katelyn Audette is a skilled TMS Clinical Operator since Fall of 2018. She studied in Boston MA at Newbury College, graduated with BA in Psychology and Social Science. She treats clinical patients daily trained with numerous devices, some involving research as they are given the option to participate in ongoing research studies for their treatment series if interested. She thoroughly enjoys the face- to- face interactions with those being treated. Her goal is to provide the best possible care for each patient, understanding that building relationships based on trust and comfort make a large difference in the patient experience.

Melissa Burt, RN

TMS Research Nurse

Ms. Melissa Burt graduated with a Bachelors of Science in Human Development and Family Studies from the University of Rhode Island (URI) in 1996. She completed an internship while at URI at Butler Hospital’s partial hospital in 1996 then shortly after, she was hired as a mental health worker.  She then received her CNA license and subsequently her RN license in 2004. She has worked for many years on the inpatient units at Butler with children, adults, and geriatrics.  In 2007, she crossed over to Mood Disorders Research and eventually to the TMS clinical service.

Audrey Tyrka, MD, PhD

TMS Physician

Dr. Audrey Tyrka received her MD and PhD in medicine and psychology through a combined program at the University of Pennsylvania. She completed the psychiatry residency at the Warren Alpert Medical School of Brown University with research training in clinical neuroscience. She is the Director of Research at Butler hospital, and also directs our Laboratory for Clinical and Translational Neuroscience. Dr. Tyrka is Professor of Psychiatry and Human Behavior at Brown and Director of the NIMH-funded R25 Research Training Program in the Brown psychiatry residency program. Co-Director of the Initiative on Stress, Trauma, and Resilience in the Brown Department of Psychiatry and Human Behavior, Dr. Tyrka's program of research is focused on discovering the social, behavioral and molecular mechanisms of risk and resilience in children and adults with a history of early adversity and trauma. She also has interest and experience with research and clinical work using neuromodulation approaches to treat depression and post-traumatic stress disorder, and is an attending psychiatrist in our TMS program.

Amy Halt, MD, PhD

TMS Physician

Dr. Amy Halt received her MD and PhD in Pharmacology from the University of Iowa. She then moved to Brown University, where she completed adult psychiatry residency training as well as a geriatric psychiatry fellowship. She is a Clinical Assistant Professor in the Dept. of Psychiatry and Human Behavior at Brown University. She has been an attending inpatient psychiatrist at Butler Hospital since 2014. Currently, she is the Unit Chief of the Senior Specialty Unit. She is active in teaching at all levels of medical training, including supervising medical students, adult psychiatry residents, and geriatric fellows (psychiatry and medicine) on the geriatric inpatient unit. She is also the Education Coordinator for the Brown Geriatric Psychiatry Fellowship.

Benjamin Greenberg, MD, PhD

TMS Physician

Dr. Benjamin Greenberg has a BA in psychology from Amherst College, a PhD in neurosciences from UC San Diego, and an MD from the University of Miami, with psychiatry residency at Johns Hopkins. He then led adult OCD research at NIMH, where he performed the first transcranial magnetic stimulation (TMS) study in that illness. At Butler Hospital and Brown since 2000, he has focused on invasive neurosurgeries including ventral capsulotomy and deep brain stimulation (DBS). FDA humanitarian approval of DBS for intractable OCD in 2009 was based on that work. His NIH funding has included R21, R01, U01, P50, and P20 grants.  He has a secondary focus in psychiatric genetics.  As a clinical psychiatrist, he has treated OCD for thirty years; and over the past five years has also treated PTSD, he previously led Butler outpatient services.  He currently directs the COBRE Center for Neuromodulation at Butler Hospital and co-directs the Center for Neuromodulation and Neurotechnology (CfNN) at the Providence VAMC (PVAMC), in both roles focusing on noninvasive brain stimulation.

Lawrence Price, MD

TMS Physician

Dr. Lawrence Price attended the University of Michigan, where he  received a B.S. with highest honors in psychology and high distinction in 1974, followed by an M.D. in 1978. After an internship in internal medicine at Norwalk Hospital, he completed a residency and fellowship in psychiatry at Yale University. From 1982 until 1996, Dr. Price was on the faculty in the Department of Psychiatry at Yale University, where he served as Associate Professor and Director of the Clinical Neuroscience Research Unit at the Connecticut Mental Health Center. Since 1996, he has been Professor of Psychiatry at Brown University. From 1996 to 2012, he was  Clinical Director, Director of Research, and Chair of the Institutional Review Board at Butler Hospital in Providence, Rhode Island, subsequently serving as Chief Medical Officer from 2012 until 2014. He was President of Butler Hospital and Executive Chief of the Brain and Behavioral Health Service Line of Care New England from 2014 until 2017. He was identified by the Institute for Scientific Information as one of the top ten authors of high-impact papers in psychiatry from 1990 to 1999. In addition to his research activities, Dr. Price has received numerous awards for his teaching and clinical work, and is Editor of the Brown University Psychopharmacology Update and Editor (with I. Stolerman) of the Encyclopedia of Psychopharmacology, Second Edition.

Brian Tesar, MD

TMS Physician

Dr. Brian Tesar received a B.A. with honors in Chemistry from the University of Chicago in 1987. He studied medicine and biochemistry and received his M.D. from the University of Illinois in 1992. Dr. Tesar completed a psychiatric residency program with Washington University in St. Louis in 1996. After completing his training, Dr. Tesar cared for patients in a variety of roles: as staff psychiatrist and day hospital medical director at the Cape Cod and Islands Community Mental Health Center(1996-2000), as medical director of Gosnold on Cape Cod outpatient clinics(2000-2004), as staff psychiatrist for AHRC New York(2005-2009), and as medical director of the Kent Hospital (Warwick, RI) psychiatric care unit (2009-2017). Since 2017, Dr. Tesar has served as staff psychiatrist at Butler Hospital (Providence, RI) in both the inpatient and partial hospital programs. Dr. Tesar is also a self-taught computer programmer whose experience includes development of a database system and dynamically driven website for a real estate company in New York City. Dr. Tesar has a strong interest in developing computer systems that enhance psychiatric care.